Antihistamines

Question: Is there a major difference between Claritin and Clarinex?

Answer: Claritin is loratadine, which is metabolized in the liver to produce desloratadine, which is Clarinex.

Question: Why do I get sleepy from Clarinex? I never got sleepy on Claritin. I tried immunotherapy, but had to quit because I had severe reactions. Is there something else that I can try or look forward to?

Answer: At certain doses, both Claritin and Clarinex can cause sleepiness. If Claritin worked well without sleepiness, you should go back to it. Allegra is an alternative since sleepiness is not a side effect.

Question: Are any over-the-counter allergy medications effective at reducing mild allergy/hay fever symptoms...in my experience, I haven't found one that helps at all.

Answer: Over-the-counter antihistamines are effective. Benadryl works well but can make you drowsy. Claritin is a non-sedating antihistamine and is now sold over the counter. Antihistamine/decongestant combinations are also effective. Their effectiveness can be increased by not using a single preparation for longer than a couple of weeks. Cromolyn is available over the counter with the name Nasalcrom, and it is effective but must be used four times a day or more.

Steroids

Question: What are the long-term effects of nasal steroid use?

Answer: Nasal steroids - in the usual doses - can be tolerated for long periods of time by most people. These effects may range from cracking and minor bleeding in the nose to a very small but measurable increased risk of cataracts. The risk of osteoporosis and diabetes cannot be ruled out when used at higher doses.

Question: Can nasal steroids cause thrush?

Answer: Yes, if the medicine reaches your throat and is swallowed. This is rare with a nasal steroid but the treatment is the same as with an inhaled steroid. Rinse your mouth after use of the nasal steroid. If you use an inhaled steroid, make sure you use a spacer.

Question: If someone is using a nasal steroid spray, such as Nasonex or Flonase, is it okay or even desirable to also use an oral antihistamine such as Zyrtec or Claritin?

Answer: Yes, both antihistamines and nasal steroids can be used, depending on the clinical symptoms and the response to treatment. Many patients use both.

Question: I have always had normal nasal (rhinitis) symptoms, but this year I have also developed asthma and food allergies. Now, in the last three weeks, as trees are budding, I have developed severe skin "itchiness." I am very sensitive to various fabrics - cotton seems to be the only thing I can tolerate. My questions: Is this a typical allergic response? What can I do to stop the itching?

Answer: Many people with nasal allergy (allergic rhinitis) and springtime allergies develop significant symptoms such as itchy skin, as you are experiencing. Another phenomenon known as oral allergy syndrome occurs when cross-reactions between allergy pollen and food allergens cause itchiness and swelling in the mouth and throat after eating the food allergen. Antihistamines are a good treatment for oral allergy syndrome and for skin itching. You should see an allergist and use all prescription medications in conjunction with a physician's consultation and proper monitoring.

Other Medications for Allergies

Question: How does Singulair help with allergies? Why is it suggested to take in the evening?

Answer: Singulair is a prescription medicine approved to help control asthma in adults and children as young as 12 months and to help relieve the symptoms of seasonal allergies in adults and children as young as 2 years. The reason why it works with both conditions is because the mediators present in asthma are also present in allergic rhinitis. In all of its studies, Singulair has only been tested with a single dose in the evening, so that is how it has been approved for use (it was originally formulated for relief of nighttime asthma symptoms). However, it is a once-a-day medication so its effects should last twenty-four hours. Singulair has no side effects such as drowsiness or dryness, like antihistamines. Singulair is a leukotriene antagonist, different than antihistamines.

Question: I've heard that work is in progress on a new drug that will inhibit the action of IL-4, specifically an IL-4 receptor blocker. Do you know the status of such a drug?

Answer: The IL-4 work with the receptor antagonist by Immunex is on hold because of equivocal results in helping asthma. Other companies are going ahead with trials of an anti-IL4 humanized monoclonal antibody. The results are too preliminary to comment on at this point.

Question: I would appreciate some information on the upcoming IgE medication and the effects on spring allergies. How does it relate to allergy? When will it be available? Who would benefit from it? How would it benefit a person who has asthma-like myself? Where can I read more about it?

Answer: A relatively new anti-IgE medication is called Xolair (omalizumab). It is indicated for treatment of moderate to severe allergic asthma and has not been approved for nasal allergy (allergic rhinitis). However, it has been shown in studies that it can relieve hay fever and/or nasal (rhinitis) symptoms, but it must be injected and is far too expensive to justify its use for nasal symptoms only. Most people can treat their hay fever with much cheaper medication that doesn't require injections.

Question: What is the cause and how do I get relief for watery eyes? I am a 70 yr old male with asthma. My eyes water constantly, so much so that tears run down my face. This occurs when I go outside (e.g. grocery shopping, walking, etc).

Answer: Watery, itchy eyes are usually related to allergic conjunctivitis, although other eye conditions can cause these same symptoms. There are a number of eye drops (e.g. Pataday, Zaditor, Alocril) eye drops can relieve the symptoms of itchy, watery eyes that you describe. Check with your doctor about trying this.

Question: I have hay fever really bad in the spring and the fall; how soon before my bad season starts should I take my allergy meds?

Answer: Most medications are effective within a matter of days. Cromolyn takes a full month to be completely effective. Allergy shots may take as long as two years.

Question: What is the best precaution to take knowing that I have severe reactions to insect bites (like swelling, blisters)? Are there certain over-the-counter medications that I should always carry?

Answer: Patients who have had systemic reactions to stings by vespids (honey bee, wasp, hornet, yellow jacket) or ants are at risk for allergic reactions that may be life threatening. Systemic reactions are those that cause low blood pressure, shortness of breath, gastrointestinal symptoms or swelling or rash distant from the site of the sting. Individuals who have experienced such reactions should carry injectable adrenaline that comes in pre-loaded syringes under the names Ana-Kit or Epi-Pen. These preparations are available by prescription only but can be life saving and should be carried by all patients with a history of systemic responses to these insects. It is especially important to carry one of these preparations if one is going to be participating in activities in remote areas. Antihistamines can be helpful but are not adequate for a life-threatening situation.

Drug Interactions and Other Respiratory Diseases

Question: Can people with COPD take Allegra? I know Sudafed and others are not recommended for COPD patients.

Answer: People who have allergies as well as COPD can take antihistamines for their allergies. Sudafed is a decongestant and a different type of medicine.

Question: I have COPD and problems with my sinuses. I currently use Claritin-D. Is there another medicine that will work better to clear up the drainage? I am also on Serevent, Atrovent, Proventil and Uniphyl. I rarely take Proventil.

Answer: Claritin-D can help sinus drainage for people with allergy and sinus drainage problems. Other antihistamines and decongestants can work including Allegra-D and Zyrtec-D. There are also over-the-counter antihistamine and decongestant combinations that help with sinus drainage. These medicines, however, would have no direct effect on COPD - the medicines you are already taking are treatment for COPD.

Question: Are there new medications for allergy out that are safe for those with COPD?

Answer: New treatments are being tested all the time for COPD. It would be best to check with your pulmonary specialist.

Allergy Medications, Pediatrics, and Pregnancy

Question: Is Claritin dangerous if I am pregnant? I heard something about Claritin and Hypospadias last week in the news.

Answer: All medications should be used cautiously in pregnancy. Older antihistamines, such as pyribenzamine and benadryl, are probably the safest to use in pregnancy. Claritin is FDA pregnancy category B, which is considered safe.

Question: Can you suggest a safe medicine for a nursing mother with nasal allergy (allergic rhinitis) and itchy eyes and skin?

Answer: First of all, every pregnant or nursing mother and her doctor must carefully weigh the benefits to the woman against the risks to her fetus or infant when using any medication. Always inform your doctor if you are pregnant, planning a pregnancy or breastfeeding before using any medicine. That being said, nasal steroids are generally well tolerated during pregnancy and by nursing mothers. Benadryl is probably the safest antihistamine to use because it's been around the longest, although it can cause drowsiness. Many of the newer antihistamines have either not been tested, or they have been found to be present in breast milk. Great caution should be used with all of these medications and certainly not before a thorough consultation with your doctor.

Question: I have a six-month old baby with eczema, and he sneezes all the time. His eyes are not red or watery, but at night he has trouble breathing from congestion. His nose is not runny, though. Do you have treatment suggestions? Is he too young for seasonal allergies? We are getting ready to try Triaminic based on our pediatrician's suggestion.

Answer: Allergic sensitization is possible during pregnancy and soon after birth. However, currently available clinical tests are not very reliable in making the diagnosis. Food allergy is known to play a role in eczema. Consult with your allergist. Pediatric Triaminic as a combination of antihistamine and decongestant is OK.